位置:博客 > 许筱艺 > 与世界卫生组织驻华代表面对面 Interview with Dr. Bernhard Schwartländer, WHO Chef de Cabinet

与世界卫生组织驻华代表面对面 Interview with Dr. Bernhard Schwartländer, WHO Chef de Cabinet

Dr. Bernhard Schwartländer took up his position as WHO Representative in China in September 2013. Before joining WHO in China, he served as Director for Evidence, Policy and Innovation at the UNAIDS headquarters in Geneva, Switzerland and as the United Nations Country Coordinator on AIDS in Beijing, China.

Prior to these assignments, Schwartländer held a number of senior international positions including Director for Performance Evaluation and Policy at the Global Fund to Fight AIDS, Tuberculosis and Malaria, Director of the World Health Organization’s HIV Department, and as Director of Evaluation and Strategic Information at UNAIDS.

Schwartländer is a medical doctor and holds a doctorate in medical epidemiology. His work is published in many scientific journals and books. He brings extensive experience in development policies as well as infectious disease epidemiology and programming at global and country levels, and holds appointments as adjunct professor with Peking and Tsinghua Universities in Beijing.[2]


Xu: Dr. Schwartländer, next month marks the start of your fifth year as WHO World Representative (WR) to China. Reflecting on your role so far as WR, what are some of the highlights of WHO China and for you personally over the past four years?

Schwartländer: The journey of the office in China has been quite amazing. There is so much knowledge in China. It’s not really our role to come to China and to tell them what to do. There are some of the smartest people globally in all of the areas that we work in. So it’s really much more about practical solutions to solve some of the significant problems that we have in China when it comes to delivering health. It’s more like putting the best minds of the world together with the best minds of China, to analyze the situation and find solutions with the experience that we have access to around the world, and I think that has been amazingly successful.

China is a whole continent. It’s not just one country like any other. It has the largest population in the world. There are a huge differences between the east, west, south and north. We have to focus our work on a number of areas because otherwise we couldn’t make much difference in anything. If you dilute too much, you don’t get any results.

It’s very clear that one of the major areas to focus on was supporting the largest health reform project in the world. Not only because of the size of the issue, but also because of the amazing move China is making from a largely dysfunctional health system to a very modern, 21st century health system from which the world can also learn from. There is massive work that has been going on, so obviously that was one of the areas that we decide we need to put some of our strongest capacities on in order to help support this reform effort.

We also looked into some of the most pressing health challenges in China beyond the system’s development. We’re looking particularly in the areas where we can have a big difference. Whenever there is something linked to behavior, that is something you can influence, and something you can change. That’s always a very important entry point. Smoking tobacco was one of the areas that we felt needed to be tackled and could certainly be changed. So that was the second top priority.

We also worked in regulatory strengthening, another area China has recognized that they are lacking behind. There’s a clear ambition to develop a system—a modern, world-class system—that makes sure that the quality of all drugs, health items, foods and cosmetics meet the highest quality standards. This is another top priority that we focus a large part of our time on. However, many requests come in other areas as well, but 80% of our time is focused on these big priorities.

Xu: Early on this year, Chinese President Xi Jinping met with WHO’s then Director-General (DG) Margaret Chan in Geneva to sign an agreement to radically improve access to healthcare beyond China, through the One Belt One Road initiative. From the 17th to 19th of August this year[3], current DG Dr. Tedros Ghebreyesus attended a series of high profile events, including one on One Belt One Road[4]. Could you please share with us some of the key takeaways and areas in which the WHO will be continuing to contribute to President Xi’s ambitious project and vision?

Schwartländer: I would like to start with answering the question by mentioning that the One Belt One Road initiative is not just a project. What probably better describes it is a commitment and style of working together built on the thousands of years experience gained through cultural exchange.

It’s really less about the concrete things like projects. As you mentioned, it’s really about how can we use cooperation between societies. I say that it is about more than just countries because it is ultimately about people who exchange goods, who exchange ideas, who exchange cultures and language. On a personal level, they are building friendships and even families across cultures and nations. I think that’s fundamentally at the heart of this initiative, and it’s fundamentally also the vision that China has for a much more global world. President Xi has spoken impressively about globalization and cooperation several times this year. First in the World Economic Forum in Davos, before he came to Geneva to visit WHO, President Xi also spoke to the UN in Geneva where he reiterated his vision of a world that actually comes together rather than being divided. This is, therefore, a fundamental vision much beyond health.

Now, we are of course very happy that the current Chinese government recognizes how important health is in everything related to development. Fundamentally, One Belt One Road is about joint sustainable development. Health must be the centerpiece, because ultimately everything goes back to health. If you’re not healthy, there cannot be economic development, there cannot be peaceful and happy development; and there cannot be equity unless there’s health for all people. So it’s really a centerpiece of the sustainable development agenda and the Belt and Road initiative. I think that under this strong commitment to and recognition of the role of health was the basis for this Belt and Road health summit.

And of course within that we had a number of discussions–what does this mean concretely? It’s not a very narrowly defined area of work because health should be in all policies. Health should be thought about when countries agree to build roads between them. There are different ways of building roads and cities—investing in infrastructure that is healthier or less healthy—that supports people to thrive in healthy ways. That’s what’s at the core of this thinking.

There’s one area which really stands out though, and that is what the incoming WHO Director-General is saying: we need to keep the world safe. There are many places where outbreaks are happening, where diseases are suddenly spreading, and it’s been recognized by the world over the last years more than ever. Whenever something happens in one place—like Ebola, SARS, Zika, and many other attacks—these viruses don’t need a visa, they cross borders in minutes. An outbreak or a disease is only one flight away from anywhere else in the world nowadays. We need to recognize that we can only make sure that everybody in the world is safe if we jointly build systems that make societies resilient against disease. We are only as strong as the weakest among us.

One of the key themes cast under this Belt and Road initiative is how we can work together to strengthen these systems, with a focus on health emergencies. In the longer-term we can work together to build health systems that make societies resilient to health problems, and make sure that anybody along the Belt and Road initiative has full access to all the health services that they need.

Xu: Shifting our focus to domestic issues now, one of Dr. Ghebreyesus’ top priorities as Director-General is further promoting universal health coverage (UHC), which is arguably a broad and perhaps abstract concept to some people partly because of the technical language. Given that, how can ordinary people, especially youth, contribute directly to WHO campaigns and help in reaching its goals in China and around the world?

Schwartländer: I think it’s really important to reflect a little bit about what “universal health coverage” means. It does mean that every person, no matter where they live, who they are, and what they do, has access to the services they need to stay healthy without getting into financial hardship. I think that that’s critical, all these components are very critical.

It is also very important that we do not limit this thinking to hospitals and places where medical care is delivered; that should be the last resort. The world has recognized that prevention and keeping people healthy is one of the most important pieces of universal health coverage. There is no system in the world that can cope with the tsunami of non-communicable diseases that is rolling over all of our societies. And we can’t cope with that in our systems if we only focus on doctors and hospitals. Universal health coverage is prevention, treatment, and care of people in all aspects of health. It helps keep people healthy and makes sure that they don’t suffer drastic economic losses when they get sick.

There are so many actions that young people can take to help societies and themselves. I very often say that healthy aging starts at birth. What we’re talking about is that we want to make sure that people stay healthy throughout their lives. We are all getting older. It’s healthy aging that you’re looking for so that you can enjoy life rather than just counting years. Now, that does start at birth, it is about how we feed our children, how they can develop their health and whether they have enough exercise. We have to make sure that young adolescents, for example, don’t start smoking. The majority of smokers today started in their youth. So of course we’ve been looking to young people to take charge of their own health and not follow extremely unhealthy trends that industries try to sell them because they will make money from it.

Xu: Let’s discuss more about inequity. Despite China’s remarkable progress in healthcare reform, inequity remains a crucial challenge to China. What are some of your thoughts here, especially given that China will be introducing a new Essential Health Law later this year?

Schwartländer: I think that’s a very important question. In China in the past the healthcare system has basically broken down. It has mainly broken down because there was no good primary healthcare system. 80% of the things that do happen to people when it comes to health should be best taken care of in a primary care setting where people can receive the care, the treatment and the prevention work that they need to become healthy and stay healthy. For many reasons which we could discuss, that system has broken apart.

Now, what has happened in China is that there is extremely sophisticated healthcare in many places, like Shanghai and Beijing. There, you get world-class medical care. There are world-class treatment sites and some of the best operation rooms. But these excellent facilities are only available to a small number of the population. Some wealthy people can afford a type of healthcare that is completely unthinkable to people in a less-wealthy province. It’s a real challenge to develop a country like China in a way that there’s equity, where not only the rich in a fancy city get all the healthcare, but the poor also get the basic care that they need.

Now, you mentioned the health law and I think that’s critically important. Because what we have also seen is that there are real challenges, not only in China but for health systems around the world, in finding efficient ways of having universal health coverage. Some of the very best models have a mix of private and public partnership here. There are many models, including in my own country, Germany, where many previously public hospitals are now under private management. If you are in the private sector delivering healthcare, it has to happen in a way that not only the richest of the rich can pay for it. If you want to build a hospital and make money you have to do it in a way that benefits everybody and not just those who have the big money. That’s a very simple way of saying it, but unless you have such a policy framework and standards developed that can be looked at and enforced, you may very quickly aggravate the inequities that I’ve already describes between the west, east and also the south, but also inequity within places where the richest people are able to buy the best and the finest. If you don’t have a strong regulatory framework, all the good doctors will to migrate into those places where they can make money. This not only makes it impossible for others to buy similar services because they don’t have the money, but it also may weaken the public sector because there’s a strong migration away from the public side. So, you need to be very thoughtful of these matters. You have a responsibility for a whole society, and while this public-private mix is very important, you need to make sure that it does happen within the framework that takes into account the potential outfalls.

Xu: Earlier, you referred to the new health law in China. What do you see as the essential ingredients to effective law and policy in the realm of public health in China and across the world?

Schwartländer: There are a number of extremely powerful examples in many countries, including China. Many examples are related to child care, where societies have realized that making sure mothers do not fall sick, or even die when they give birth is important. Giving birth was a high cause of mortality in all of our societies over the centuries. This is where protection is the most important; it’s the young mothers and the babies that carry the future of our societies. And still today, some of the most effective measures here are the vaccine programs, to make sure that children are covered effectively by some of the best things that we have in medicine. Effective vaccines can protect children for life and protect them from diseases, which can cause enormous suffering with long term effects for children. So these are clearly huge success stories.

Now, I will focus my other success stories more on the preventative side, because there are enormous things that have happened in science development and research. All of these things are just stunning successes that have kept many of us alive, including myself. I may not be alive and talking to you without some of these progresses in medicine, I know that. All of these things are just enormous. But I think medicine also has to be measured by the way we can keep people healthy so that they don’t fall sick.

There are, of course, incredible success stories, and I have to come back to smoking, because it is just one of those things that are just so ridiculous. How can you sell products to people which basically kill them, and make a huge amount of money with it? This is really something that I cannot possibly accept. But we have seen many societies that have changed the the influence of the tobacco industry. For example, places, like New York, that are under strong leadership are now smoke free cities. Beijing and Shanghai are really now following suit with those models. I think the prevention of diseases is incredibly important and one of the largest success in medicine, which is often forgotten about because we tend to look at the science and the research, the machines and the pills. But in terms of the number of people that it can save, these prevention approaches can add up to even larger numbers.

Xu: You mentioned in a previous interview that everything that happens in China is huge due to the country’s size and huge population. China is the “smoking dragon,” with a significant population of smokers and consequently second hand smokers as well. One of the challenges that China is still facing, despite the law that was passed in recent years, is tobacco usage and related policies. You wrote an op-ed last year that highlighted several inadequacies in the enforcement of this new law, specifically the section that attempted to make all indoor spaces in the city 100 % smoke-free. Speaking one year later, now in 2017, what are some of the apparent positive aspects that have happened in accordance to this law in the past year, and what are some areas that require more work on China’s part?

Schwartländer: You’re right, one of my personal success stories that I see from my work, and my team in China, is the introduction of the smoke free laws in three of the major megacities. Our work has contributed [to this positive result], but we are clearly not the only ones. It was a partnership between many like-minded people working together. But I think our contribution has helped to protect many Chinese people from the deadly outcomes of smoking. We’re talking about primarily protecting non-smokers from being routinely exposed to the unhealthy fumes of cigarettes. But by doing this, we have seen that even the smokers themselves realize more and more that what they’re doing is unhealthy for their families and also for themselves. The number of smokers that actually appreciate the non-smoking laws in cities is enormously high.

The state regulates certain drugs because those substances can be unhealthy. But when it comes to smoking, it seems very difficult to say that you are not allowed to smoke in a public indoor space, when, obviously, your individual behavior creates a large health risks to others, rather than stepping outside and smoking somewhere where you don’t expose others to your smoke and the deadly fumes that you produce. It seems to be so difficult to get to this recognition, which should be an extremely simple step.

We were very frustrated that these laws didn’t move faster and that it was such a huge struggle, even after the three major cities had passed these laws successfully and seen really good results. There is still a struggle to have this law implemented nationwide. You still hear all of these silly arguments and they are all arguments placed by the tobacco industry. We hear the argument that “it is such a cultural thing for the Chinese to smoke.” But this is just garbage, in every society tobacco companies have managed to lead us to smoke. Seeing chairman Mao with a cigarette cannot be interpreted as a Chinese cultural thing. This has happened everywhere. Churchill was smoking cigars, it has been happening because the tobacco industry has been very successful in selling these products and making people addicted. We have seen in many societies all around the world, how societies have changed, and how they are recognizing that smoking really has a massively negative impact and how it has to change. I have already spoken about New York and the leadership of Mayor Bloomberg and how the whole place turned around and is now a model city of smoking. Italy, which is not known for being the most strict of societies, people there are creative and I love the place, but there, overnight, people were happy to stop smoking inside, in bars, with no problem at all. So why couldn’t that happen in a place like China?

One thing that really frustrates me is the production of cigarettes in China. China has the largest number of cigarettes produced worldwide and the largest number of smokers in one country worldwide. All of these cigarettes are produced by state owned companies. So the state actually produces something, which if used as intended, kills a large part of the users. Now how can that be? How can the state make something that kills people? This is something that really frustrates me and something that I think needs to be changed. So there is still a lot of work that we have to do in China.

Xu: We have talked about some cultural dimensions to consider earlier today. The next question is actually from a colleague of mine at the journal: how do you think AIDS is stigmatized in China and is that different than how it is stigmatized in western countries such as Germany, the US, and the UK? If so, why?

Schwartländer: This is a very good question, and stigma is indeed one of the major factors that influences the epidemic of HIV worldwide. One thing that is quite different in China is that China never had a law that made homosexual behavior illegal. Many other societies actually had legal regulations that made homosexual behaviors illegal and therefore poses challenges, even legal challenges, to people who feel they have a preference to the same sex. This makes it extremely difficult to deal with the stigma because they know whatever they do has to happen secretly and silently. That is, of course, a recipe that makes it difficult to engage these populations in health promotion programs. There are still societies where there is a death penalty for homosexual behavior.

Now in China, such laws did not exist. But what did exist were extremely strong social norms, which is something that also can create enormous stigma. People are expected by their families to get married and have families of their own. If that does not happen, there are parents that won’t talk to their children anymore, creating enormous pressures on those that have different desires or plans in life.

This goes through all parts of society. In the healthcare sector, people cannot talk about it because it’s not accepted, and people also fundamentally don’t understand and cannot talk about it. That goes back to one of the specific things that I see in China more than other countries. The sex education and reproductive health education is very weak in China. Sex is not talked about at schools and it is very difficult to talk about it in families. I, personally, know so many people and colleagues whom I really like and are personal friends, but when it comes to sexual education, they don’t believe their children need it, because their girls don’t have boyfriends or their boys don’t have girlfriends, or because their child is busy at school and doesn’t need it. Of course, those are such silly statements, because they all have friends and have sex, we know that. There is a huge number of pregnancies and abortions, which is a consequence of people not having the right sexual education.

I think that is a prominent feature in China that we have to address. Young people, in particular, need to have access to the right information. Young people also need to be given information on homosexuality because that is also a component of moving into a healthier future. It is difficult to change the beliefs of older people because they are not so flexible in their thinking and find it more difficult to accept. However, the younger generation must be provided with the right information and the right mindset so that they can actually take health education forward in a new way, one that does of course include homosexuality which is so often a component of HIV epidemics.

Xu: Having just now discussed about young people in China, let’s now move on to the topic of China’s significant aging population. How do you think the Chinese government will address the healthcare concerns that accompany China’s large aging population, and how will China change its healthcare policy to accommodate this rising need?

Schwartländer: Aging is a phenomenon that is very interesting. In many ways it is a good thing. The fact that life expectancy has increased is a fundamental reflection that we have been living in a healthier way. We have access to better food and better services, especially at birth. Many children don’t die, and more and more mothers are healthier. So many measures have been taken so that people live longer and healthier lives. What is happening at the same time is that we have a lower number of births and smaller families, which means that the proportion of the society who are elderly is increasing around the globe. It is very rapidly increasing in China, the numbers are just staggering and there is a number of ways we have to think about this. One, we have to realize that healthy aging starts at birth, so this is not just about looking into what happens when old people get sick. Second, we have also to look at how we can make sure that people, when they grow older, are healthy and stay healthy. If elderly people are healthy, we don’t need to look into what are the special needs of old people when they come to the hospital. So looking at how we keep them healthy, and keeping them away from hospitals as long and as effectively as possible is important.

There are many things around healthy lifestyles that have to start early in life and have to continue when people grow older. But there is also a new dimension that we haven’t thought about: what do we do with a population, which is up to one third of the total population, who are basically out of a job because they are retired? But they are there, they are healthy, they are productive, and they want to participate in society, so how can we include them? How can we keep them as active members of our society? Because if they are part of something, feel useful, are not excluded from the process of society and can feel part of it, it can have a massive impact on their mental health. It keeps them younger, and it also keeps them healthy. There are many examples of that. So there is a whole new dimension that we need to look at when we talk about aging, which is much more than the traditional care and medical sector in order to really create societies with healthy aging.

XU: We have covered a lot of content on China so far. We will now address aspects of your career as well as the UN as a whole. You have highlighted the importance of cooperation—which for various stakeholders means learning from each other. Based on your first hand experience working and leading various international organizations, what would you say are some of the ways that different UN agencies can learn from each other internally?

Schwartländer: Now, we have a large number of United Nations agencies today, and when you go back to the idea of the United Nations, it was an extremely noble idea which came up in the last century. It actually came up after the world went through a number of real crises including the terrible second World War, which included nations from across the world being drawn into a violent war. They realized—the world realized—that this could not go on forever. We have to collectively carry a responsibility for mankind. We have to collectively take responsibility for the globe. It cannot be that certain places just don’t care about what they are doing in a way that has a massive impact on others when it comes to, for example, pollution and climate change. There is a recognition that we live in not only a social ecosystem, but also an environmental one, in which everybody around the globe, wherever people live, are connected. We need to find political solutions that not only allow friendly countries to have such exchanges, but also big countries that are not so closely connected. They need a platform where such exchanges can happen, and that’s the basic idea behind United Nations system.

Over the years, quite a number of specialized agencies or programs have developed from specific issues, like the World Health Organization. Health is a topic that requires people with specific expertise to come together in an agency, in an organization that really focuses on that area. It’s the same with many others .As you already pointed out, many of these special interests or foci, are actually connected. Let’s take UNICEF. They look into the wellbeing of children as their main objective, but how can that happen without looking at their health, and how can the World Health Organization work together with UNICEF to make sure that those interconnections are effectively identified and addressed with different organizations, different units, different departments taking their responsibilities but working closely together across the silos to deliver services to the people. When it comes to people, there’s one child, there’s one health, there’s one wellbeing and there’s one education. Unless we bring these things together, people won’t understand us.

So, what I think is important is what organizations can learn from each other, beyond the technical issues—I’m always fascinated talking to my fellow United Nations colleagues because there’s so much to learn. I mean, all of these sectors have very specific aspects that relate to the life of people in other countries, so it’s good to discuss. But I think what is really important, and I think it’s fundamentally also on the sustainable development agenda is that we have to get away from thinking about our specific objective—“I’m only dealing with health, you’re only dealing with education.” We have to recognize that ultimately it is about people, wherever they live. For one person getting up in the morning, they don’t have to think about a specific disease; they think “How can I be healthy? How can I be productive? How can I make sure that I can get food and water to my family”. Unless we go back to that and say “What’s the need of the people and how can we collectively deliver what these people need in a given place?”, we will not be successful in our drive for a better humanity. So, number one is tear down the silos, talk to each other with the people at the center. Number two: a message for my United Nations colleagues is to stop thinking too much at headquarters. So much discussion goes on in the headquarters. Go out into the countries and look into what the people need and how we can actually collectively help them. And that will get us a long way in overcoming these different silos, overcoming competition for resources or whatsoever. At the end of the day, for those people whom we serve, none of this matters. They have a very clear desire to have a good life, and we have to collectively deliver this.

Xu: Has working for the UN been a long-term aspiration for you?

Schwartländer: When I went to medical school, I wasn’t even thinking that I would end up in public health, and certainly not thinking about working for the United Nations. So I must admit that the jobs that I first took when I joined the World Health Organization, and later UNAIDS in the United Nations system developed because of the work that I did in my own country. They developed out of the cooperations that we have, for example, within Europe, recognizing that when it comes to public health, you have to think beyond the borders, living in a globalized world. I had more and more contact with people in the United Nations, and there came a point in time when I felt that my expertise and aspirations to work in public health would actually really mesh well with the work of the United Nations, and it just happened. I was really happy and got great opportunities to work on a global agenda. Along the way, in several ways I was very happy. I was offered the opportunity to work not only for one organization, UNAIDS, but also for the World Health Organization. I’ve worked for the World Bank for some time, and I’ve worked with the Global Fund to fight AIDS, tuberculosis and malaria, and all of these gave me incredible insights into the different aspects of development cooperation and how to most efficiently work with partners in countries to support them to build systems. So, this is essentially never about our own organizations. The work we’re doing is fundamentally to make sure that we can help national governments, national counterparts, NGOs and others to build better systems in their own countries. And I have learned so many aspects of that and how to do that better. So, I really feel very, very privileged with my career and the opportunities that I got, but for most of these jobs, I didn’t plan them ahead. They came along, and I jumped on them because it was a huge opportunity and I was very, very happy with the many different positions I was able to carry throughout my career.

Xu: What kinds of suggestions do you have for students who are interested in working for law and policy in the public health sector?

Schwartländer: One thing I would like to tell students is that it’s a very privileged type of work to work in public health. Medical students especially take the job and take the studies because they are eager to bring health interventions to people. We all start to work with patients. We learn how the body works, how health works, how bugs work, and how we can protect people from illness. Most of us, with very few exceptions, realize how important it is to work in the right policy environments so that the right decisions are being taken and the frameworks exist to really make sure that everybody has access to the right interventions from prevention to treatment to care. And that often works through policy and law development. It’s incredibly important that we get the systems right, that nobody suffers financial hardship when they have to go to the hospital or have an accident, and all of those are legal frameworks that you have to put in place. There are financial frameworks that you have to put in place, so it cuts across all kinds of sectors and departments. It’s the social security aspects of health; it’s the development aspects of health; it’s the financial aspects of health, which are enormous.

Today, in China, there are still about 50 to 70 million people in poverty. Almost half of those people are in poverty because of health, so how can you even think about bringing people out of poverty if you don’t look into health? All of that relates to policy development. In a larger sense, it’s a very noble area of work, and it can be an extremely satisfying area of work because you’re dealing with large populations much beyond an individual patient. It can be very rewarding to see how your work contributes to the health of many people, to give them access to health. For me, it’s the best thing I can do. ,.

Xu: As an epidemiologist, you love numbers, and as a people leader, you love to share the stories and meanings behind all of those numbers. What is your take on the future of public health in relation to big data analysis?

Schwartländer: I think dealing with big data offers enormous opportunities to improve health for people, and it’s very interesting what many people don’t quite understand. We do differentiate between what we call large data and big data. The difference is that we say large data is sharing larger data sets, which is possible today because we have better tools, better computers and better software that allows us to manage large data sets. For example, by combining health information and patient information of many large hospitals around the country we understand better how treatment works or what type of diseases people come to the hospital with. But in a sense, it’s still the traditional thinking in medicine but just applying it to bigger data sets.

Now, for, big data the way we describe it is actually to look into information that is available beyond the health sector and seeing how that can actually help us to understand health better, and to predict, for example, health problems earlier. Based on the fact that there are lots of things happening every day—like what people are buying on the Internet or elsewhere—that could give us incredible insights into the health of the people and the health risks of the people. It’s the type of food they buy, the type of devices they buy, the toys they buy, the decisions that they take which give us hints on how people think, their objectives in life, for example, and all of that can help us understand how that links to health. Some of the main research companies have access to huge amounts of data, and it can allow us to recognize very early whether there is an outbreak-type situation, be it influenza or be it other things, because when people do not feel they may start to buy medicines. If you only look at the individuals you don’t recognize those trends. They don’t show up to hospitals, but if you look at huge population numbers across the board, look at financial transactions with credit cards, you can very early on pick up that people buy certain medicines, buy certain things that are linked, or very likely linked, to health situations, or just look for health conditions on search engines.

So, there are many aspects of data and information that are available, but that are not directly connected to health. If you put that together in a creative way, you can actually get incredibly useful information about public health, public health policy, and how to also help influence this in a healthier way. That’s when I see the strength of big data, and in many ways, we are only at the beginning of this discussion. It is happening. There are approaches, for example, to build smarter and healthier cities, including regulation of traffic which can increase road safety and decrease pollution. All of these things are happening. It is the beginning of something that really I think is big.

Xu: That concludes our interview, Dr. Schwartländer. Thank you so much again. It’s been such a pleasure talking to you.

[1] The interview was conducted on August 22nd, 2017. It was originally published by the Claremont Journal of Law and Public Policy, for which I serve as editor-in-chief.

[2] Source: http://www.wpro.who.int/china/about/representative/en/

[3] one week before this interview took place

[4] Editor’s note: The terms “One Belt One Road” and “Belt and Road Initiative” are used interchangeably.

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